Comparing cord blood transplantation and matched related donor transplantation in non-remission acute myeloid leukemia
Comparing cord blood transplantation and matched related donor transplantation in non-remission acute myeloid leukemia
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DOI：
10.1038/s41375-021-01474-0
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发表时间：
2021-11-24
期刊：
影响因子：
11.4
通讯作者：
Yanada, Masamitsu
中科院分区：
文献类型：
--
作者：
Shimomura, Yoshimitsu;Sobue, Tomotaka;Yanada, Masamitsu
脐带血移植（CBT）是一种替代供体移植方法，具有快速可用性和诱导更有效的移植物抗白血病效应的可能性，导致未缓解复发和难治性急性髓细胞白血病（R/R AML）患者的复发率较低。本研究旨在研究CBT的影响，与人类白细胞抗原匹配的相关供体移植（MRDT）相比。该研究纳入了2451例在2009年1月至2018年12月期间接受CBT（1738例患者）或MRDT（713例患者）的未缓解R/R AML成人患者。使用倾向评分（PS）匹配分析评估了5年无进展生存期（PFS）和CBT的预后影响。PS匹配后，患者特征在两组之间平衡良好。CBT组的5年PFS为25.2%（95%置信区间[CI]：21.2-29.5%），MRDT组为18.1%（95% CI：14.5-22.0%）（P = 0.009）。调整后的风险比（HR）为0.83（95% CI：0.69-1.00，P = 0.045）;这是由于复发率的降低（HR：0.78，95% CI：0.69-0.89，P < 0.001）比NRM的增加（1.42，1.15-1.76，P = 0.001）更明显。在该人群中，CBT与同种异体HSCT后的5年PFS相关性优于MRDT。
Cord blood transplantation (CBT) is an alternative donor transplantation method and has the advantages of rapid availability and the possibility of inducing a more potent graft-versus-leukemia effect, leading to a lower relapse rate for patients with non-remission relapse and refractory acute myeloid leukemia (R/R AML). This study aimed to investigate the impact of CBT, compared to human leukocyte antigen-matched related donor transplantation (MRDT). This study included 2451 adult patients with non-remission R/R AML who received CBT (1738 patients) or MRDT (713 patients) between January 2009 and December 2018. Five-year progression-free survival (PFS) and the prognostic impact of CBT were evaluated using a propensity score (PS) matching analysis. After PS matching, the patient characteristics were well balanced between the groups. The five-year PFS was 25.2% (95% confidence interval [CI]: 21.2-29.5%) in the CBT group and 18.1% (95% CI: 14.5-22.0%) in the MRDT group (P = 0.009). The adjusted hazard ratio (HR) was 0.83 (95% CI: 0.69-1.00, P = 0.045); this was due to a more pronounced decrease in the relapse rate (HR: 0.78, 95% CI: 0.69-0.89, P < 0.001) than an increase in the NRM (1.42, 1.15-1.76, P = 0.001). In this population, CBT was associated with a better 5-year PFS than MRDT after allogeneic HSCT.